Bolivia, Plurinational State of

Health insurance for children and mothers slows child mortality in Bolivia

A UNICEF-supported government health insurance plan means Eulalia de Noe and other Bolivian mothers living in poverty won’t have to pay for their children’s treatment.

By Jane O’Brien

Every year 10.5 million children die before the age of five, the vast majority from preventable causes. On 18 September, a high-level Child Survival Symposium in New York will galvanize action to reduce child deaths by two-thirds by 2015, in line with Millennium Development Goal 4. Here is the second in a series of UNICEF reports in the run-up to the symposium.

NEW YORK, USA, 14 September 2006 – An estimated 2.5 million children in Bolivia live in poverty. It lies at the root of the sickness and malnutrition that cause the vast majority of deaths among children under five. Many live miles from the nearest health services and can’t afford the cost of care.

“In the countryside there are no doctors,” says Eulalia de Noe, who has walked several miles to bring her four children to see a doctor at the nearest hospital in San Asunción de Guarayos. “There is not even a health centre, so we have to come here to be able to have a check-up.”

Eulalia de Noe and her children have to walk several miles to reach the nearest health centre.

Unrestricted care

Ms. de Noe’s baby needs routine vaccinations and all four children are suffering from diarrhoea, which is responsible for more than a third of infant deaths in Bolivia. But thanks to a new approach to juvenile health care, supported by UNICEF, she will not have to pay for their treatment.

The new and extended government insurance policy also enables doctors to offer unrestricted care to children under five and help their mothers during pregnancy.

“Our maternal mortality rate is very low – almost zero,” says Dr. Edil Toledo from the Hospital de San Asunción de Guarayos. “That’s happened in the four years since I’ve been here and it’s mainly due to the application of insurance.”

UNICEF has supported the policy by training health workers to use the system properly and make better use of resources. It is also promoting community initiatives that benefit newborns in particular, who account for a third of all deaths of children under five.

Challenges remain

Dr. Gonzalo Mancilla, a neonatal specialist at Munaypata Hospital, says child mortality rates are improving through medical care but more needs to be done to tackle the underlying causes.

“Basically, Bolivia’s hospitals and its health services are treating a large number of children with acute respiratory diseases, diarrhoea-producing illnesses, and on top of these, malnutrition is also a major influence in the cause of mortality,” he says.

As a result of the UNICEF-supported integrated care strategy, child mortality rates are dropping in Bolivia. But challenges remain. For example, 12 per cent of children under 10 don’t have birth certificates, which means they lose their legal right to basic health care.